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General NPI Number Information
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NPI Number | 1679148613
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Entity Type | Individual
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Provider Name | CRYSTAL JANICE PUTT CPHT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 910 JOE MANN BLVD
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City | MIDLAND
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State | MI
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Zip | 48642-8903
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Country | US
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Telephone | 989-835-6364
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Fax | 989-835-1984
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Provider Business Mailing Address
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Address Line | 1956 W NORTH UNION RD
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City | AUBURN
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State | MI
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Zip | 48611-9585
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Country | US
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Telephone | 989-402-7664
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Fax | 989-835-1984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303015830
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License Number State | MI
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